The effect of traditional Chinese medicine fumigation and washing as a complementary and alternative therapy on the recovery of joint function after development dysplasia of the hip in children: A protocol for systematic review and meta-analysis.

BACKGROUND: Development dysplasia of the hip (DDH) is a common childhood orthopedic disease in clinic. The cause of DDH is not yet clear. If DDH is not treated promptly or correctly, it will seriously affect the life quality of the child. At present, surgery is the main means of treating older DDH, but it is easy to appear development dysplasia of the hip after surgery, and the joint movement is limited after surgery. For modern medicine, it has not many treatments to solve this problem. As one of the commonly used treatment methods, but the effect of routine functional exercise is not ideal. Traditional Chinese medicine fumigation and washing belongs to the category of Chinese medicine external treatment, which can directly act on the focus. It has the functions of relaxing muscles and tendons and removing obstruction from meridians, activating blood to eliminate stagnation. It has achieved good effects in relieving joint disorders, but it is lack of the high-quality evidence support, so there is controversy about the clinical application of traditional Chinese medicine fumigation and washing. This study will conduct a systematic review to compare the application effect and safety of traditional Chinese medicine fumigation and washing as a complementary and alternative therapy and traditional rehabilitation training in the treatment of postoperative joint function recovery after development dysplasia of the hip in children. The research results will provide evidence-based medical evidence to support the choice of treatment for the disease. METHODS: Using computer to retrieve PubMed, ScienceDirect, Web of Science, EMBase, Cochrane Library, WANFANG Database, CNKI, and VIP Database, CBM, and using the method of combining mesh words with item words to retrieve the Chinese and English databases, to retrieve the randomized controlled study on the application of traditional Chinese medicine fumigation and washing on the recovery of joint function after development dysplasia of the hip in children. The retrieval time is from January 1990 to January 2021. Two researchers screen and evaluate the quality of the retrieved literatures according to the inclusion and exclusion criteria. In the event of a disagreement, a third researcher will join the discussion to resolve the disagreement. Using Revman 5.3 software to conduct meta-analysis. RESULTS: This study will compare the application effect and safety of traditional Chinese medicine fumigation and washing as a complementary and alternative therapy and traditional rehabilitation training in the treatment of postoperative joint function recovery after development dysplasia of the hip in children. CONCLUSION: The results of this study will be published in an internationally influential academic journal to provide evidence-based medical evidence for the selection of supplement and alternative therapies on the recovery of joint function after development dysplasia of the hip in children. ETHICS AND DISSEMINATION: This study does not involve specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of this study. OSF REGISTRATION: DOI 10.17605/OSF.IO/RUHK5.

Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip with Prolotherapy Injection versus a Supervised Progressive Exercise Control.

BACKGROUND Osteoarthritis secondary to developmental dysplasia of the hip (DDH) is one of the major causes of hip pain and disability. The aim of the study was to compare the effectiveness of prolotherapy (PrT) injections versus exercise protocol for the treatment of DDH. MATERIAL AND METHODS There were 46 hips of 41 patients who had osteoarthritis secondary to DDH included in this study. Patients were divided into 2 groups: treated with PrT (PrT group; n=20) and exercise (control group; n=21). Clinical outcomes were evaluated with visual analog scale for pain (VAS) and Harris hip score (HHS) at baseline, 3 weeks, 3 months, 6 months, and a minimum of 1-year follow-up. In PrT group clinical results were also compared in Crowe type I-IV hips. RESULTS Between group analysis revealed no significant between group differences at baseline. Dextrose injection recipients out performed exercise controls for VAS pain change score at 6 months (-4.6±2.6 versus -2.8±2.5; P=0.016), and 12 months (-4.5±2.4 versus -2.9±2.5; P=0.017) and for HHS at 6 months (24.2±14.0 versus 14.8±12.4; P=0.007) and 12 months (24.3±13.4 versus 16.5±11.3; P=0.018). CONCLUSIONS To our best knowledge, this study is the first regarding the effects of an injection method in the treatment of osteoarthritis secondary to DDH. According to our study, PrT is superior to exercises. PrT could provide significant improvement for clinical outcomes in DDH and might delay surgery.

Five-year follow-up outcomes of comprehensive rehabilitation in Korean siblings with cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome: A case report.

RATIONALE: Cerebral, ocular, dental, auricular, skeletal anomalies (CODAS) syndrome is a very rare multisystem disorder, which shows malformations of the central nervous system, ears, eyes, teeth, and skeleton that was first reported in 1991. Only a few cases that sporadically occurred have been reported worldwide. The research investigating the pathogenesis and patterns of CODAS inheritance is still ongoing. There is no satisfactory treatment for this rare genetic disease yet. Due to the lack of curative medical treatment, rehabilitation could play a major role in treatment for genetic disease. PATIENT CONCERNS: To our best knowledge, the 2 children described in this study are the only CODAS syndromes siblings reported in the world so far. These Korean siblings show highly distinctive features consisting of developmental delay, cataracts, vulnerability to tooth decay, epiphyseal dysplasia, and anomalous ears. DIAGNOSES: CODAS syndrome. INTERVENTIONS: Comprehensive long-term rehabilitation treatment during 5 years. OUTCOMES: We report on the progress of the comprehensive long-term rehabilitation treatment at 5-year follow-up. Their fine motor and language skills development improved similarly to that of same-aged children. We observed the positive effect of rehabilitation on the quality of life. LESSONS: The therapy of genetic disorders is challenging for pediatric neurologists and pediatric physiatrists. We suggest that rehabilitation is the best treatment currently available for this genetic disease that yields satisfactory therapeutic effect.

Exploring the experiences of parents caring for infants with developmental dysplasia of the hip attending a dedicated clinic.

Specialised DDH (developmental dysplasion of the hip) clinics are developing around Ireland but are, however, variable in how they are operated. A DDH clinic was set up in the South-east of Ireland in 2002 with the goal of achieving an integrated care pathway between the orthopaedic surgical team and nursing team, working to an explicit protocol while also fostering a strong collaboration with the ultrasound department. This paper aims to explore the effectiveness of this dedicated clinic in the Southeast of Ireland.

Can Radiographs Predict the Use of Modular Stems in Developmental Dysplasia of the Hip?

BACKGROUND: Abnormal anatomy frequently results in the use of a modular stem in patients undergoing primary total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). However, because these stems are not always available in the operating room, it would be helpful if standard radiographic views could be analyzed in such a way that patients whose femoral anatomy might call for stem modularity could be anticipated before surgery. To our knowledge, no such parameters have been defined. QUESTIONS/PURPOSES: In the senior author's practice, we used femoral neck anteversion of more than 25° as a determinant for use of a modular stem. Given this criterion, we asked if we could reliably identify plain film radiographic parameters of the femur that predict the use of modular stems. We looked at the following: (1) the neck-shaft angle based on the anteroposterior (AP) radiograph (alpha); (2) the neck-shaft angle from the crosstable lateral radiograph (beta); and (3) the calculated femoral anteversion angle. METHODS: We reviewed preoperative radiographs from 50 of 67 patients (79 hips) who had a primary diagnosis of DDH and underwent primary THA from January 1999 to February 2007 inclusive. Hips with prior femoral-sided surgery (n = 2) or without preoperative films (n = 19) were excluded. Furthermore, patients with bilateral hips had the second hip excluded (n = 8). Twenty-one of 50 received a modular femoral stem based on the criterion of intraoperative neck-shaft anteversion of greater than 25° as measured by the senior surgeon (CLP), whereas the remainder received tapered nonmodular stems. There were no differences in age, sex, height, or weight between the modular stem group and tapered stem group. Radiographs were evaluated to record the parameters listed. RESULTS: Patients in whom modular femoral stems were used had a greater mean AP (alpha) neck-shaft angle compared with patients who received tapered nonmodular stem (152°; 95% confidence interval [CI], 146°-157° versus 137°; 95% CI, 134°-141°; p < 0.001) with an optimal cutoff point for determining the use of modular stems of ≥ 142° (receiver operating characteristic [ROC] area = 73%). Hips in which modular femoral stems were chosen had a smaller mean lateral (beta) neck-shaft angle (152°; 95% CI, 148°-157° versus 161°; 95% CI, 158°-164°; p = 0.003) with an optimal cutoff point of ≤ 153° (ROC area = 65%). Hips in which modular femoral stems were used had a higher femoral anteversion angle (mean 45°; 95% CI, 37°-54° versus 21°; interquartile range, 17°-25°; p < 0.001) with an optimal cutoff of ≥ 32° (ROC area = 80%). CONCLUSIONS: Preoperative radiographs anticipated the use of modular stems during THA for DDH in a practice where modular stems were chosen on the basis of a neck-shaft angle of greater than 25° measured at surgery. We found that this could be predicted on preoperative radiographs based on smaller lateral neck-shaft angles, steeper AP radiographic neck-shaft angles, and increased femoral anteversion calculated using these angles. Prospective studies are needed to better determine if these cutoff values adequately predict the use of modular stems.

Desarrollo locomotor en pacientes con displasia del desarrollo de cadera y pie equino varo congénito que recibieron tratamiento ortopédico antes del año de vida. Estudio prospectivo comparativo / Locomotor development in infants with developmental dysplasia of the hip or idiopathic clubfoot undergoing orthopedic treatment. Prospective comparative study

Objetivos: Diversas afecciones de presentación temprana en la niñez, como la displasia del desarrollo de la cadera (DDC) y el pie equino varo congénito (PEVAC), requieren de tratamiento ortopédico, limitando la movilidad activa de las extremidades inferiores por un período prolongado. El objetivo es evaluar el impacto sobre el desarrollo locomotor del tratamiento ortopédico en niños menores de un año de vida. Pacientes y métodos: Se analizó una cohorte prospectiva de pacientes consecutivos con diagnostico de DDC (24 pacientes) y PEVAC (32 pacientes), tratados de manera ortopédica entre enero del 2007 y junio del 2009. Se utilizó como control un tercer grupo de 50 niños sanos. Se evaluaron el tiempo con ortesis y la edad al sentado, gateo y al comienzo de la marcha. Las comparaciones entre los 3 grupos fueron realizadas con una prueba de Kruskal-Wallis y entre sí con una prueba de U de Mann-Whitney. Un valor de p < 0,05 fue considerado como significativo. Resultados: El análisis de muestras independientes mostró que las medias de las edades en meses para sentarse entre los 3 grupos (control, DDC y PEVAC), 6,12, 6,42 y 6,19, respectivamente, fueron similares (p = 0,249). Las medias para gatear, 8,84, 9,38 y 9,17, fueron similares, aunque con una discreta tendencia a la significación estadística (p = 0,08). Las medias para el inicio de la marcha, 12,14, 13,21 y 12,41, fueron distintas entre los 3 grupos (p < 0,001). Conclusión: El tratamiento ortopédico de la DDC y el PEVAC en niños menores de un año retrasa levemente el desarrollo locomotor normal (AU)

Objectives: Several disorders of early childhood, such as developmental dysplasia of the hip (DDH) and clubfoot, requires orthopedic treatment that limits active mobility of the lower extremities for a period of time. The aim of our study was to evaluate the impact on locomotor development of the orthopedic treatment in infants less than one year-old. Patients and methods: The study included a prospective cohort of consecutive patients diagnosed with developmental dysplasia of the hip (Group A, 24 patients), and clubfoot (Group B,32 patients) treated from January 2007 to June 2009. A third group (Group C) of 50 healthy children was used as control. The variables evaluated were: months with a brace, age to sit withoutsupport, age at the start of crawling, and age at the beginning of walking. The results obtainedwere analyzed. Comparisons between the three groups were performed using the Kruskal-Wallis test and Mann-Whitney test. We chose a value of P<0.05 as level of statistical significance. Results: The analysis of independent samples showed that the mean age at which the patients began to sit were similar: 6.12, 6.42 and 6.19 months, respectively (P=0.249). The mean age for crawling was similar, although with a slight trend toward statistical significance: 8.84, 9.38 and 9.17 months, respectively (P=.08). The age at which they started walking was different between the three groups: 12.14, 13.21 and 12.41 months, respectively (P<0.001). Conclusion: Orthopedic treatment of DDH and clubfoot in children less than one year-old slightly slows down the course of normal locomotor development (AU)

Treatment of developmental dislocation of hip: does changing the hip abduction angle in the hip spica affect the rate of avascular necrosis of the femoral head?

Avascular necrosis (AVN) of the femoral head is a serious complication in the management of developmental dislocation of the hip. Increasing the abduction angle increases its stability but compromises the vascularity of the femoral head. From our database of 240 children treated for developmental dislocation of hip by the two senior authors between 1998 and 2008, we defined two groups of children who underwent closed or medial open reduction of the hip after a failed Pavlik treatment or if patients presented late. In group 1, the reduced hip was immobilized in around 90° flexion, 60° abduction, and 0-10° internal rotation. In group 2 the hip was immobilized in around 45° of hip abduction with flexion and internal rotation as before. The first and second authors independently analysed these two groups blinded to the hip abduction angle. Our hypothesis was that a reduction in the hip abduction angle would reduce the incidence of AVN in the second group without compromising the stability. All eligible children were included, and there were 42 children in group 1 and 44 children in group 2. An almost equal number of children underwent closed and medial open reduction in both the groups. The age at reduction was a mode of 6 months (range 6-13 months) and 7 months (range 7-12 months), respectively. The abduction angle in the first group had a mode of 60° (range 52-70°) and the second group had a mode of 45° (range 38-50°). Radiographic evidence of AVN as described by Salter and colleagues was seen in eight children (19%) in the first group and seven children (16%) in the second group (P=0.78). Redislocation occurred in one child in the second group and none in the first group. In summary, the results show a nonsignificant reduction in the incidence of AVN when the hip abduction angle was reduced with no significant increased risk of redislocation.

Displasia del desarrollo de la cadera / Dysplasia in the development of the hip

La displasia del desarrollo de la cadera provoca cambios anatómicos que dan lugar a una coxartrosis precoz. La etiología y la patofisiología de la displasia de cadera no se conocen con exactitud, aunque se han determinado factores de riesgo. Se han establecido programas de despitaje neonatal clínicos y ecográficos que lleven a un diagnóstico precoz de esta afección. Un diagnóstico en los primeros meses de vida es fundamental porque permite obtener una cadera normal y evitar la aparición de una coxartrosis precoz. El tratamiento debe conseguir reducir la cadera, evitando la aparición de una necrosis avascular de la cabeza femoral, y normalizar el desarrollo del acetábulo. Existen opciones ortopédicas y quirúrgicas que deben ser conocidas para lograr un éxito en el tratamiento (AU)

Developmental dysplasia of the hip (DDH) causes anatomical changes that cause early coxarthrosis. Although risf factors have been determined, the aetiology and physiopathology remains exactly unknown. Neonatal screening with physical examination and ultrasound have been stablished in order to diagnose this disease early in life. A diagnosis in the first months of life is essential as it enables a normal hip to form and prevent the appearance of early coxarthrosis. Treatment principles are to be able to reduce the hip without provoking avascular necrosis of the femoral head, and to normalize the acetabular development. Knowledge of the orthopaedic and surgical options is essential in order to achieve success in the treatment (AU)

Experiences of young women living with developmental dysplasia of the hip: insight into their experiences of surgery and recovery.

OBJECTIVE: To explore the experiences of young women with developmental dysplasia of the hip explicating the impact of peri-acetabular osteotomy surgery and recovery in the short and longer term. DESIGN: Postings of five, selected women on an online active message board aimed at women with developmental dysplasia of the hip were analysed. Interest lay on their postings after they had had peri-acetabular osteotomy surgery. Data analysis was performed through the approach of interpretive phenomenological analysis. RESULTS: The time length of the postings for the cases ranged from 1 year to 6 years, and the number of postings varied substantially, from 48 to 591. Two major concepts were prominent across participants' accounts. The first concept, 'body image', centred on affects on the women's self-esteem and body image. The second, 'the long road to recovery', highlighted 'the emotional and physical battle of learning to walk' and concerns with 'saving my joints'. CONCLUSION: Developmental dysplasia of the hip potentially provides a critical case for exploration of the process of how a disability can affect confidence, self-esteem and body image. Recovery from this condition requires enormous effort, resilience and commitment from the women.

Developmental dysplasia of the hip.

The close interaction between community practitioners and young families provides an invaluable opportunity for prevention, education, support and even diagnosis in cases of developmental hip dysplasia. This article provides a brief overview of the condition, including clinical findings, screening protocols, 'hip safe' practices, and common treatments that may be encountered in the community.

Biomechanical evaluation of different abduction splints for the treatment of congenital hip dysplasia.

BACKGROUND: Abduction splints for the treatment of hip dysplasia normally operate on curbing the legs at the hip flexion and abduction. The forces are absorbed in different designs of shoulder straps and thus diverted to the shoulder and the spine. The present study is the first comparing these undesired forces of two spread orthoses and subsequently the transmitted forces to the infant's spine. METHODS: Between March 2009 and October 2009 the hips of 290 infants were investigated by ultrasound within the first 3 days after birth. Thereof 20 infants with a hip dysplasia Graf type IIc, D or IIIa met our inclusion criteria and were investigated with a Tübinger and a Superior abduction splint. Biomechanical evaluation was performed by using a high-sensitive strain gauge sensor applied to the infant's orthoses between pelvic harness and shoulder straps. FINDINGS: The transmitted forces to the infant's shoulders correlated significantly with their body mass (P<0.05). Maximal forces on the shoulder of the infants and subsequently transmitted forces on the spine were significantly higher (P<0.05) with the Tübinger splint (range 7.6N to 32.3N; arithmetic mean M: 13.7N) in comparison to the Superior orthosis (range 0.0N to 3.5N; M: 0.7N). INTERPRETATION: The Superior orthosis works with primary load transmission to the pelvic bone. Using the Tübinger splint the shoulders of the newborn infants are loaded with a maximum of 93.9% of their body mass. This may influence the development of the growing infant's spine.

[Congenital torticollis]. / Torticolis congénital.

Congenital torticollis is a very common postural deformity, characterized by a more or less severe retraction of sternocleidomastoid muscle. Any treatment, else that "good sense" counsels given to the parents, is indicated. The evolution is spontaneously favorable in the majority of cases before the age of one year old. The elimination of differential diagnosis (vertebral and/or neurological malformations, ocular, tumor) is the key-point. Screening of congenital hip dislocation is mandatory because the physiopathology is the same in both diseases. A remaining torticolis after 18 months of age may be an indication to sternocleidomastoid muscle lengthening.

Análise radiográfica dos fatores prognósticos no tratamento do quadril displásico inveterado / Radiographic analysis of prognostic factors in DDH treatment after walking age

OBJETIVO: Avaliar os resultados do tratamento cirúrgico da Displasia do Desenvolvimento do Quadril na idade da marcha. MÉTODOS: Avaliamos 33 quadris operados entre novembro de 1992 e setembro de 1997. A média de idade foi 4 anos e 5 meses na ocasião da cirurgia e 11 anos e 7 meses quando avaliamos os resultados. O seguimento médio foi de 10 anos e 2 meses. Realizamos o encurtamento femoral, redução cruenta e osteotomia pélvica (Salter ou Chiari). Radiograficamente avaliamos: grau da luxação, índice acetabular; ângulo acetabular; arco de Shenton; linha de Hilgenheiner; coeficientes c/b, c/h, centro-acetábulo e cabeça-acetábulo; largura da cartilagem trirradiada; relação cabeça trocânter; esfericidade da epífise femoral; ângulo de Wiberg; necrose avascular e anisomelia. Os parâmetros radiográficos foram avaliados nos períodos pré-operatório, pós-operatório imediato e tardio. RESULTADOS: Verificamos estatisticamente melhora significante destes no momento pré-operatório para o pós-operatório imediato (p=0,0001) porém não houve variação significante entre o pós-operatório imediato e o tardio (p=0.5958). CONCLUSÃO: Pela classificação utilizada para avaliação dos resultados observamos 23 (69,70 por cento) bons, 5 (15,15 por cento) regulares e 5 (15,15 por cento) maus resultados.

OBJECTIVE: To evaluate the results of surgical treatment of Developmental Dysplasia of the Hip (DDH) treated in the walking age. METHODS: We evaluated 33 hips in 30 patients operated between November of 1992 and September of 1997. The mean age was 4 years and 5 months at surgical period and the mean age at the last evaluation was 11 years and 7 months. The mean follow up time was 10 years and 2 months. We performed femoral shortening, open reduction and pelvic osteotomy (Salter or Chiari). Radiographic assessment considered: acetabular index; acetabular angle; Shenton's line; Hilgenreiner's line; the c/b, c/h, acetabulum-center and acetabulum-head ratios; the width of the triradiate cartilage; the trochanter and femoral head relationship; femoral head sphericity; Wiberg angle; avascular necrosis and leg length discrepancy. These parameters were measured and compared in pre-operative, early and late post-operative period. RESULTS: After statistical analysis we observed a significant decrease in these parameters from pre-operative period to immediate post-operative period (p=0.0001) and those have not changed between the immediate post-operative period and late post-operative period (p=0.5958). CONCLUSION: By the classification used we observed 23 (69.70 percent) good, 5 (15.15 percent) regular and 5 (15.15 percent) bad results. None of these radiographic parameters were relevant to predicting final results.

D.D.S.H.: developmental dysplasia of the spastic hip: strategies of management in cerebral palsy. A new suggestive algorithm.

Hip problems in cerebral palsy are relatively frequent (25-75%). Subluxation and dislocation of the hip is proportional to the neuromuscular involvement and is often due to alteration caused by spastic muscle forces acting on the femoral head in the acetabular cavity. The EMMA approach (Early Multilevel Minimally-invasive Approach) has been designed to restore muscle balance, decrease hip migration and prevent bone deformities thereby avoiding future pain with minimal biological cost to the patient. EMMA is suitable for most patients, especially those with increased tone, poor muscle control and selectivity, Reimer Index (R.I.) 20%. We consider age and R.I crucial prerequisites for treatment steps. EMMA 1) age 2-4 years, RI 20%: multilevel injection of botulinum toxin in case of muscular hyperactivity without morphological alterations of the couple muscle-tendon (contractures). EMMA 2) age 4-6, RI 20%: multilevel aponeurectomies in case of muscular hyperactivity with morphological alterations of the couple muscle-tendon (retraction). EMMA 3) early bone surgery (growth plates). This approach has been adopted in the last 4 years to prevent bone deformities and give early mobilisation and early control of the pain. EMMA is simple to apply even in infants, both for hip containment and to decrease spasticity.

[Nonsurgical treatment of developmental dysplasia of the hip]. / Konservative Behandlung der Hüftreifungsstörung.

The introduction of hip ultrasound for developmental dysplasia of the hip (DDH) has led to earlier diagnosis and treatment of this condition. The younger the child, the greater the potential of acetabular remodelling. An early-initiated, differentiated therapy according to the Graf classification has led to good treatment results. Nevertheless, there is still a number of residual dysplasia and a risk for late sequelae even after successful ultrasound-guided therapy. Therefore, long-term follow-up of treated hips until skeletal maturity is necessary. Whereas there is no doubt about the good results of the treatment we apply, its economic effectiveness still has to be proven.

[Reliability of digital measurement of acetabular index in hip dysplasia to the time children start walking]. / Reliabilität der digitalen Messung des AC-Winkels bei der Hüftreifungsstörung an Röntgenaufnahmen zum Gehbeginn.

AIM: An assessment of the reproducibility of the acetabular index on the basis of anteroposterior radiographs of the pelvis was performed in order to rule out residual dysplasia of the hip in the second year of life. METHOD: 51 consecutive patients (41 girls, 10 boys) with congenital dysplasia of the hip (35 bilateral, 16 unilateral) were included. Approximately at the time children started walking (mean age: 13.9 months; range: 10 - 22 months), digitised anteroposterior radiographs of the pelvis were recorded. Acetabular indices were measured bilaterally and blinded by two observers (O1 and O2), then classified according to the normal values of the hip joint described by Tönnis et al. (normal = lower single standard deviation [s], light dysplasia = above single standard deviation [s - 2 s] and severe dysplasie = above double standard deviation [2 s]). O2 repeated a second set of observations 6 weeks after the first. 306 values of the acetabular index (O1: 102 values; O2: 204 values) were statistically evaluated. Reliability was expressed by Pearson's correlation coefficient (PCC) and 95 % confidence interval. The rater agreement of the classification into normal values of the hip joint was calculated with the kappa coefficient. RESULTS: The PCC for intraobserver/interobserver reliability was 0.928/0.875. The 95 % confidence interval for intraobserver reliability was +/- 3.1 degrees and for interobserver reliability - 3.1 degrees /+ 5.9 degrees . A comparison of the first series of measurements by O1 with the series of measurements by O2 presented congruence in 66 of 102 hip joints classified according to the normal values of the hip joint as described by Tönnis. In 36 hip joints the classification was deviant, in 15 the classification differed between normal and s, in 21 between s and 2 s. The kappa coefficient of 0.51 showed moderate interobserver agreement. CONCLUSION: The reproducibility of radiological surveillance in congenital hip dysplasia, approximately to the time children start walking, can be considered as adequate. Correct positioning of the patient and exact definition of radiological landmarks are essential. In spite of good statistical values for reliability, decreasing accuracy in classifying into Tönnis' normal values of the hip joint is seen with increasing degree of dysplasia. In marginal cases, before coming to the decision for operative treatment, a second reading, ideally by the same observer and with a chronological shift, is advisable.

Biomechanical investigation of ambulatory training in patients with acetabular dysplasia.

The purpose of this study was to investigate the effectiveness and safety of ambulatory training in patients with acetabular dysplasia. To achieve this, we studied the hip joint moment in subjects walking with laterally and horizontally elevated arms and changing speeds as a form of training to strengthen hip joint abductor muscles. We studied eight women with pre- or early stage hip disease (center-edge angle of Wieberg 18.5 degrees to -3.0 degrees ) and six healthy women. In exercise task 1 the subjects walked at a rate of 90 steps/min, with abduction of 90 degrees in the shoulder joint ipsilateral or contralateral to the affected hip joint, and either no load or a 1 kg weight in either hand. In exercise task 2, walking speed was changed in three stages from 60 steps/min (s-gait), 90 steps/min (n-gait), and 120 steps/min (f-gait), with both hands swinging freely. Using results from a three-dimensional motion analysis system, the hip joint moments were calculated. In both the healthy and the acetabular dysplasia groups, the abduction moment of the hip joint decreased significantly with ipsilateral elevation and increased significantly with contralateral elevation. There was no significant change in hip flexion moment in either group. The hip extension moment decreased significantly with contralateral elevation, but no significant changes were seen in ipsilateral elevation. In the walking rate variation, the extension hip moment in fast gait was higher than in slow gait. It was concluded that ambulatory training with contralateral horizontal arm elevation may be an effective way of increasing hip joint abductor muscle strength. Ipsilateral arm elevation decreases gluteus medius muscle tension and is an effective way of ambulatory training for people with compensated trendelenburg gait. Variable speed walking is an effective exercise method that can strengthen extensor muscles. Therefore, these ambulatory training methods are useful for acetabular dysplasia patients.